Allergy and Immunology

What is an Allergist/Immunologist?

• An Allergist is a doctor who specializes in diagnosing and treating allergies to pollens (seasonal or otherwise) or foods, asthma, eczema (an allergic rash), and other allergic conditions. A pediatric allergist cares for infants, children and adolescents who have these issues.
• An Immunologist is a doctor who specializes in managing problems related to the immune system.  Specifically, our immunologists at Arkansas Children’s specialize in diseases associated with an absent or poorly functioning immune system.

What is a typical new patient appointment like?

• Your child's initial visit may be scheduled by your child's primary care provider. Once we receive the request, we will mail you a packet of information about our practice and forms for you to complete to bring with you to your first visit. Please note prior to coming for your visit, you will need to arrange for a referral if required by your insurance.
   
• When you arrive for the initial visit and have completed your paperwork, your child will have their height, weight and other vital signs taken. They will be taken back to an exam room by a nurse. A registered nurse will take a thorough allergy related history.  If your child is five years of age or older and has asthma, we may order Pulmonary Function Tests (PFTs) to measure lung function.
   
• After the history is obtained and the testing is complete, the physician will see your child. He or she will review the history with you and your child and will complete a physical exam. The physician will explain the diagnosis, recommend medical therapy, and answer any questions that you might have.  If testing for allergies is necessary, the physician will discuss the process and order the required tests with the nurse. You will be given written prescriptions for any new medications along with written home care plans and medication information handouts. The entire initial visit usually takes about two to three hours. You may also see other allergy/immunology team members who help teach you how to give the recommended medical treatments (dieticians, respiratory therapist, etc.).
   
• Follow up visits will be scheduled through the appointment center as recommended by the physician.

What happens during a follow-up visit?

• Follow-up visits are important to complete the diagnosis process and to make changes in your child's medications depending on how well he or she is doing. The timing of follow-up visits varies depending on the severity of your child's illness.
   
• If your child has asthma, Pulmonary Function Tests (PFTs) are done at almost all follow-up visits if they are able to perform the test.  For specific allergic conditions, skin testing for allergies will be repeated only as needed (not likely every visit), and blood tests may be required to follow specific diagnoses for both allergic and immunologic concerns.
   
• Please come prepared for your child's follow-up visits.  It is helpful if the adult who attends the follow-up visit is very familiar with the child's day-to-day life and participates in the medical care.  Please plan to spend at least 2 hours with us for a follow-up appointment.  Some visits may be quicker if testing is not required.

What is a Pulmonary Function Test?

• We use special equipment and trained personnel to measure your child's breathing. These tests are called Pulmonary Function Tests (PFT's) or spirometry. Your child's test results are compared to predicted values based on your child's height, race, age and sex much like a growth curve.
   
• These tests are easy and fun for our patients and consist primarily of taking a big breath and blowing out as fast as possible. Interactive 'breathing games' encourage our patients to give their best effort. The equipment then measures the breath and airflow comparing it to predicted values and any previous test to monitor progress.
   
• Our physicians and their assistants are specifically trained to interpret these tests to determine the presence and progress of lung disease such as asthma. These breathing tests are recognized by the National Heart, Lung and Blood Institute as an important tool in the diagnosis and management of lung disease.

What is Allergy Skin Testing?

• Allergy skin testing, or skin prick test, checks for immediate allergic reactions to multiple substances at once.  The test is typically done to identify the source of allergic symptoms, including pollen, mold, pet dander, dust mites, and foods.  The test is typically done on the back of most children.  In order to perform the test, your child must be off all antihistamines for around one week.  Please read the packet that will be sent to you prior to the appointment for specific instructions.  The test uses small needles (lancets) to scratch the skin surface with the allergen. It is not typically painful, and your child won’t bleed or feel more than mild, momentary discomfort.  These tests usually take around 15 minutes to place, and then they must sit on the skin for 15 minutes.  This can be an “itchy” process for some of our patients.  Once we have read the test, we can provide some relief with topical steroids in the clinic, and we will remove the tests with alcohol.  If tests are positive, you will see a raised, red, itchy bump (wheal) that may look like a mosquito bite.  Based on these results, your allergist/immunologist will provide a detailed plan that includes avoidance measures for specific allergens and treatment options that will vary depending on the positive tests and the reason for testing. 

Will my child always see the same allergist/immunologist?

• All out-patient follow-up physician visits will be scheduled with the same allergist/immunologist who you saw for the initial visit. If your child is admitted to the hospital and a pulmonologist is involved in the child's hospital care, your child will be seen by the Arkansas Children's allergist/immunologist who is rounding at the hospital that day and may see someone different when/if a clinic visit is made.

Both of my children see the allergist/immunologist. Can they be seen at the same time?

• Yes, but make sure that you schedule two separate back-to-back appointments. You may contact the appointment center to ensure the children’s appointments are made on the same day. They may have appointments scheduled at different times, but you can bring them both the first scheduled appointment. For example, if one is scheduled at 9:00 a.m. and the other child at 10:00 a.m., bring them both to the 9:00 a.m. appointment.

Who should I call if my child is sick between appointments?

• If your child is having a serious allergic reaction, serious difficulty breathing or is turning blue, you need to call 911 and/or go to the nearest emergency room.
   
• If your child is having other allergic symptoms or less serious breathing trouble, coughing, wheezing or other symptoms that are related to his breathing or allergies, you should call the allergy/immunology office to speak with a nurse. The nurse can give you advice about changes in medications or help you decide if your child needs to be seen by a healthcare provider.
   
• If your child is having trouble with an earache, sore throat or rash or other general illness of childhood, please call your primary care provider.

Can my child be seen for a sick visit?

• Since we are not a primary care office, we don't have scheduled "sick visits". There may be sometimes that your child can be worked in to see a physician, but this is not always the case. When you contact the allergy/immunology office, a nurse will advise you if you need to have your child see the primary care provider or if you need to move up your regularly scheduled appointment with your allergist/immunologist. We send your primary care provider a written summary of your child's visits to our office, so he or she should be very familiar with your child's allergy/immunology care.

If I have to take my child to an emergency department for an allergic reaction, will he or she be seen by the allergist/immunologist?

• If you take your child to the Arkansas Children's Emergency Room, an Arkansas Children's allergist/immunologist will be on-call in the event that the emergency room physician needs advice about your child's allergy/immunology care. Most of the time, your child will be seen by the emergency room doctor and will not need to see the allergist/immunologist at that time. Our physicians are not available at any of the other local emergency departments.

What if I need to get in touch with my child's allergist/immunologist?

• If you need to speak with your child’s allergist/immunologist, call the allergy/immunology office to speak with a nurse. If the nurse cannot answer your question, they will get in touch with the doctor or have the doctor contact you.

Our team welcomes your referral to our practice and we look forward to helping you care for your patient. Bring any medical records that might be relevant, but don’t hesitate to call our office with any questions at 501-364-1060. The following documents and medical records will help direct your referral:

• Seasonal Allergy Appointment Recommendations - Prior skin or blood testing for allergies and relevant hospital/emergency department/primary care visit documentation. Also, stop antihistamines and over-the-counter allergy medications 7 days prior to the visit, including Benadryl, Allegra, Claritin, Zyrtec or other allergy medications.
• Asthma Appointment Recommendations - Prior skin or blood testing for allergies, relevant hospital/emergency department/primary care visit documentation, pulmonary function testing or chest x rays.  Also, stop antihistamines including Benadryl, Allegra, Claritin, Zyrtec and over-the-counter allergy medications 7 days prior to the visit.
• Food Allergy/Anaphylaxis Appointment Recommendations - Prior skin or blood testing for allergies and relevant hospital/emergency department/primary care visit documentation. Stop all antihistamines such as Benadryl, Allegra, Claritin, Zyrtec and over-the-counter allergy medications 7 days prior to the visit.
• Atopic Dermatitis Appointment Recommendations - Prior skin or blood testing for allergies and relevant hospital/emergency department/primary care visit documentation. Stop any antihistamines such as Benadryl, Allegra, Claritin, Zyrtec, over-the-counter allergy medications 7 days prior to the visit.
• Vaccine/Drug Allergy Appointment Recommendations - Hospital/emergency department/primary care visit documentation. Initial visits for patients with these concerns will be an office consultation only. If deemed necessary, the patient may be scheduled for follow-up testing. For the follow-up testing component, stop antihistamines such as Benadryl, Allegra, Claritin, Zyrtec and over-the-counter allergy medications 7 days prior to the visit.
• Insect Allergy Appointment Recommendations - Hospital/emergency department/primary care visit documentation, etc. Initial visits for patients with these concerns will be an office consultation only. If deemed necessary, the patient may be scheduled for follow-up testing. For the follow-up testing appointment, stop antihistamines including Benadryl, Allegra, Claritin, Zyrtec and over-the-counter allergy medications 7 days prior to the visit.
• Eosinophilic Gastrointestinal Disorders, Including Eosinophilic Esophagitis - Referrals for this disease must have undergone previous gastrointestinal endoscopy (scope) and have a diagnosis of eosinophilic gastrointestinal disease. Bring any medical records that might be relevant such as prior skin or blood testing for allergies, hospital/emergency department/primary care visit documentation or endoscopy reports.
• Presumed Immune Deficiency/Frequently Sick Appointment Recommendations - Laboratory, pertinent work-up or hospital/emergency department/primary care visit documentation. If the referral is for recurrent or prolonged fever, please bring a fever diary recording the temperature, the date and time of day, where the temperature was taken (mouth, forehead, ear) and the child’s activity level/symptoms at the time the temperature was taken.